Trauma-Informed Care

Abstract

Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering traumainformed care across varied medical settings. INTRODUCTIONExperiences in childhood, both positive and negative, have a significant effect on subsequent health, mental health, and developmental trajectories. For many children and adolescents, traumatic experiences are all too common. Almost one-half of American children, or 34 million younger than 18 years, have faced at least 1 potentially traumatic early childhood experience. [1][2][3][4][5][6][7] Such traumas may include those originating outside the home, such as community violence, natural disasters, unintentional injuries, terrorism, immigrant or refugee traumas (including detention, discrimination, 6,8,9 or racism), and/or those involving the caregiving relationship, such as intimate partner violence, parental substance use, parental mental illness, caregiver death, separation from a caregiver, neglect, or abuse, originally defined as adverse childhood experiences (ACEs). 10 For many children, medical events, such as injury, medical procedures, and/or invasive medical treatments, can be traumatic. Given the robust science explaining the physiologic consequences of accumulated trauma experiences on the brain and body, [11][12][13][14] there have been calls for pediatric clinicians to address childhood trauma and child traumatic stress. 10,14-16 However,

Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review

“…[18][19][20] In the USA, for example, the American Academy of Pediatrics policy statement on trauma-informed care recognises the benefits of ACE screening. 21 However, the report also acknowledges the potential risk associated with ACE screening (eg, lack of standardised screening tools, available tools to identify factors that have been derived from epidemiological studies rather than outcomes at the individual level). Further, it recommends that if ACE screening is undertaken then resilience screening occurs concurrently to buffer identified stressors and provide a holistic understanding of the child's health.…”

“…The systematic review aimed to address the following questions in routine clinical practice with children (0-11), young people (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) were excluded as the main focus of the review was on ACE and although both constructs are interconnected, they have slightly different focuses and require different screening. Furthermore, studies which evaluated ACE screening when they were completed as part of a trauma-informed care approach, for example, were also included if they met all the inclusion criteria.…”

“…Further, it recommends that if ACE screening is undertaken then resilience screening occurs concurrently to buffer identified stressors and provide a holistic understanding of the child’s health. 21 In Philadelphia (USA), an ACE task force was developed which applied a community-based approach (eg, increased screening, intervention and community engagement) as a means of addressing ACE in the community. 18 In Australia, the Royal Australasian College of Physicians position statement on inequalities in child health 22 recommended that paediatricians are trained and provided materials to address child health inequities, including comprehensive biopsychosocial assessments.…”

Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease

“…To this end, we propose a conceptual model built upon previous work highlighting how ACEs, chronic pain, and rheumatologic disease may all be interrelated and guiding our hypothesis development (Fig. 1 ) [ 15 – 18 ]. These drivers are quite common and, given the high prevalence of chronic pain and its lasting impact on physical, social, and emotional well-being well into adulthood, the relationship between ACEs and chronic pain is of significant interest not just for pain specialists, but all pediatric providers [ 19 ].…”

Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care

“…Originally viewed from the perspective of life course theory (Lu, 2014 ), the conceptualization of TIC has evolved to also include guidance for direct clinical response. Recent discussions of TIC embrace the upstream systems changes known to promote health equity, while simultaneously acknowledging the need for direct intervention when stressed individuals and families are identified (Forkey et al, 2021 ).…”